The dual burden of disease: Depression among patients with multidrug resistance tuberculosis in low-income and lower- middle-income countries: A systematic review and meta-analysis.
Agmas Wasie Abate, Assasahegn Tedla, Gashaw Mehiret Wubet et al.
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In 30 seconds
This systematic review and random-effects meta-analysis estimated depression prevalence and examined associated factors among patients with multidrug-resistant tuberculosis (MDR-TB) in low- and lower-middle-income countries. It included 23 primary studies comprising 5,734 patients. The pooled prevalence of depression was 41.89% (95% CI: 32.63-51.15; I² = 98.51%, P < 0.001). Depression was associated with female gender, financial hardship, comorbidities, greater disease severity, medication-related side effects, and perceived stigma. The authors conclude that depression is common in this population and highlight screening and psychosocial support as relevant components of care.
Key findings
- Across 23 studies and 5,734 patients, pooled depression prevalence was 41.89% (95% CI: 32.63-51.15; I² = 98.51%, P < 0.001).
- Perceived stigma was associated with depression (AOR = 3.58, 95% CI: 2.13-6.02).
- Comorbidities were associated with depression (AOR = 3.72, 95% CI: 2.11-5.38).
- Financial hardship, medication-related side effects, greater disease severity, and female gender were also significantly associated with depression.
Why it matters
Depression was common among people receiving care for MDR-TB in the settings represented, alongside clinical and social factors that may complicate treatment. Recognising this burden can help inform comprehensive assessment and support. The substantial between-study heterogeneity means the pooled estimate should be interpreted as an overall summary rather than a uniform prevalence across countries or care settings.
What to keep in mind
The pooled estimate had very high heterogeneity (I² = 98.51%), indicating substantial variation across the included studies.